Mrs Fauci on the Ethics of Encouraging Employees to get Vaccinated
If you add Ethics in the title then it must be ethical
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Should employers encourage their employees to get the COVID-19 vaccination? Of course not, they pay their employees to do a job, not lecture them on their life choices. However, some people think employers should be encouraging vaccination. If so, is it ethical?
To me the answer is no it is not, but a paper from March of this year looked at this issue. Whilst this is four months or so old, it shows the mindset of the authors which I very much doubt has changed. Although the paper is a few months old, we basically had the same information on transmission, infection, hospitalisation and death as we do now.
Very often, the first author on a scientific paper makes the most contributions to the research work whilst the last author is the person responsible for the whole project. In this paper, published in the Journal of Public Health Policy, Christine Grady is the last author, meaning she was probably in charge of putting it together.
Who is Christine Grady? Christine is a bioethicist who is currently the head of the Department of Bioethics at the National Institutes of Health Clinical Center in the US. (the paper is also funded by the Intramural Research Program of the National Human Genome Research Institute). Does she have any conflicts of interest? A quick scan to the bottom of the paper tells us she doesn’t.
That’s good then, this should be an interesting, unbiased look at the ethics of encouraging vaccination.
Hold on a minute…who is Christine married to? Christine has been married to The Science (Anthony Fauci) since 1985. Sounds like a bit of a conflict of interest to me but I’m not the bioethicist so my ethics are probably all over the shot.
Anyway back to the paper. It begins by saying the pandemic has “hindered the ability of businesses to operate at full capacity because of threats of infection…In the interest of accelerating the resumption of normal operations and increasing productivity, many employers have considered steps to increase the vaccination rates of their employees”.
This Viewpoint explores the complex ethical contours of options for encouraging employee vaccination. We focus on strategies aimed at overcoming vaccine reluctance (which can be due to resistance, hesitance, misinformation, or inertia) to facilitate voluntary employee vaccination. We argue that while such practices may raise some privacy and autonomy concerns, there are ethically acceptable encouragement strategies available to employers.
There are degrees of encouragement from distributing information to coercion and harassment.
The authors see it as a foregone conclusion that mass communication about vaccine safety and availability is “clearly acceptable”.
Emails should be sent that “not only [address] the individual benefits of receiving one of the approved vaccines, but also should reiterate employees’ responsibilities to help protect others. For example, emails and other forms of communication could describe ways that vaccination can help ensure a safe work environment, help protect the health of co-workers, and reduce the spread of disease in the larger community. These communications can and should emphasize the importance of employees not becoming vectors of transmission and the value of participating in a common effort to protect themselves and their communities.”
On the other end of the spectrum, the authors find that “broad vaccine mandates can be ethically appropriate when applied neutrally, with clear articulation about the consequences of not complying with the policy”. They say that employers have the right to mandate vaccines in the same way as they have the right to prohibit indoor smoking.
Throughout the paper, the authors are keen to stress that all types of encouragement and mandates are ethically sound, so long as they don’t lead to coercion or harassment. But they gradually chip away at what coercion or harassment actually is. I would argue that even at the lower end of the spectrum, constantly sending messages about vaccination could be considered coercion and/or harassment.
Encouragement rises to the level of harassment when it is excessive and ongoing to the point of creating “a work environment that would be intimidating, hostile, or offensive to reasonable people”. In the context of supervisor and employee relationships, harassing actions involve a misuse of power imbalances that could create unacceptably hostile working conditions and undermine the voluntary nature of the vaccination.
Targeted statistics are suggested to “spur competition or even implicitly embarrass vaccine resistors”. So long as the target audience can’t “easily” identify unvaccinated individuals then this is “ethically unproblematic”.
If the communication achieves its objective ethically, the possibility of harassment or coercion is low. Any pressure an individual may feel to get vaccinated would result from diffuse membership in a group rather than a fear about consequences targeted to a particular person.
Trusted peers should “communicate with vaccine-hesitant or misinformed portions of the workforce… [to] help to dispel myths about vaccination and share their reasons for getting vaccinated”.
Because peers don’t have supervisory authority, this type of encouragement is not seen as ethically inappropriate.
Individuals who choose to make the workplace less safe for others through their vaccine refusal should be able to foresee the possibility of this kind of social consequence [stigma and ostracization], independent of peer engagement about the benefits of vaccination.
Peers may tell unvaccinated employees “their desire to work with individuals who are vaccinated based on their expectation for a safe work environment and to avoid responsibilities falling disproportionately on vaccinated employees who can safely return in-person”.
As an example of the chipping away of their own rules, early in the paper the authors say peers not having supervisory authority makes encouragement ethically ok. But further into the paper, suddenly supervisors “ may legitimately need to ask about individual vaccination status (and legitimate exemptions) to provide important information about vaccine rates in a particular unit”.
Whilst supervisors should not make an individual feel pressured “this does not mean, however, that supervisors must immediately cut of a conversation after being told that an employee has not been vaccinated. If the employee is clearly amenable (if the person asks questions or requests assistance), the supervisor may ethically offer to provide information, answer questions or concerns, provide referrals to health care providers, and even facilitate arrangements for vaccination”.
The authors are concerned that supervisors may use vaccination status information to discriminate “but this does not preclude employers from making legitimate evidence-based policies about where to assign unvaccinated workers to minimize specific health risks”.
Ethical concerns for negative and positive incentives
Whilst noise is made about these concerns the authors conclude that modest incentives (cash payments, paid time off, free meals, spa services or product discounts) are acceptable unless they constitute undue inducement.
We stress that incentives resulting in individuals taking steps they would not otherwise have taken (deciding to get vaccinated) does not make them ‘undue.’ An incentive constitutes an undue inducement only when it “triggers irrational decision-making given the agent’s own settled (and reasonable) values and aims”. That is, is the incentive so attractive that it interferes with individuals’ abilities to make reasoned assessments of the risks and benefits associated with the activity?
While there is no consensus about the amount of money or in-kind benefit that might have this effect, participation in clinical trials may commonly offer compensation in the thousands of dollars. In that situation, risks and, hence, concern over the potential for undue inducement are greater. In contrast, the COVID vaccines approved for emergency use in the United States have been demonstrated to be highly efficacious and exceedingly safe, based on hundreds of millions of doses administered. Thus, it is extremely unlikely that commonly proposed incentives in the $100–200 range would raise concern about individuals making decisions that are contrary to their interests.
What about easing restrictions depending on vaccination status or vaccination rates in units?
Despite worries about a perception of unfairness, we argue that the selective easing of public health restrictions is ethically appropriate when done transparently and tied to objective public health guidance. Employees who choose not to get vaccinated should not slow down the gradual normalization of the work environment as the pandemic slowly subsides.
The authors conclude that it is often ethically acceptable to “inform, encourage, strongly encourage, incentivize, and subtly pressure unvaccinated people to benefit them, the organization and other employees”.
They graciously say that employees “should recognise they may say no without important negative consequences”.
There is a fine line between resistible pressure and inappropriate harassment or coercion. The authors prefer not to define this line but say stronger encouragement is warranted where employees are required to come into the office or work with the public. If employees work from home then “employers may encourage them to get vaccinated for their own sake and the sake of their families and communities”.
Legal requirements are distinguished from ethical considerations and the authors say that “where legal precedents are not clear, companies may choose to focus on minimizing legal risks”. However, the authors tell employers to “resist that instinct because ethically defensible vaccine encouragement strategies are available”.
So whilst Fauci (The Science) is pushing multiple shots of vaccine, Fauci (The Ethics) is pushing companies to ignore legal risks and “encourage” employees to get vaccinated.
Only the other day, Mr.Fauci provided a stark warning for the unvaccinated. “If they don’t get vaccinated or they don’t get boosted, they’re going to get into trouble”.
To any employers reading the ethical considerations of Mrs. Fauci, I would suggest you ignore the whole paper except for the part which says “companies may choose to focus on minimizing legal risks”. However rare complication and side effects of the vaccines may be, you just never know how an employee will react. And if your employee has a bad reaction, all I can say is good luck and I hope your legal budget is big.
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